title: Prolonged time between donor brain death and organ retrieval results in an increased risk of mortality in cardiac transplant recipients.
abstract: In cardiac transplantation longer ischemic times relate to poorer outcomes. However, brain death also promotes donor organ injury. The aim of this study was to ascertain if there was an association between longer time periods between donor brain death and organ retrieval with recipient mortality. This retrospective single centre study included 157 cardiac transplants performed between February 1999 and 2009. The time between the second brain stem death test and the cross-clamp time at organ retrieval was noted in hours. This was compared with survival time in years. Cox regression analysis was performed. The following variables were included: donor and recipient sex, age and cytomegalovirus status; donor smoking history; ischemic time and number of rejection episodes. Of the 157 transplants, 37 recipients have died. The mean follow-up was 4.1 years. The mean time between brain stem death test and cross-clamp time was 13.2±3.96 hours. Considering the above variables, the most significant finding is: increased time between brain stem death test and organ retrieval cross-clamp time, predicted a greater recipient mortality [hazard ratio (HR)=1.15; 95% confidence interval (CI)=1.06-1.24; P<0.001]. Longer delays between donor brain death and cross-clamp time are associated with a higher-risk of mortality in cardiac transplant recipients.
authors.affiliation: The Transplant Centre, University Hospital South Manchester, Wythenshawe, Manchester M23 9LT, UK. sheilaramjug@doctors.org.uk
authors.forename: Sheila
authors.initials: S
authors.lastname: Ramjug
authors.forename: Nehal
authors.initials: N
authors.lastname: Hussain
authors.forename: Nizar
authors.initials: N
authors.lastname: Yonan
mesh_terms: D000293:Adolescent; D000328:Adult; D001926:Brain Death; D004739:England; D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult